I lost my bottle of niaspan and have to wait a few more weeks before my insurance company will pay for my next bottle. Is Niaspan and slow release Niacin the same? I take 2000mg of Niaspan at night along with 20mg of Pravachol. I want to substitute the slow non flush release Niacin in place of the Niaspan until I can get the refill. Is there a big difference between Niaspan and normal slow release Niacin? Just wondering what the difference between the 2 is as I read online that Niaspan is basically slow release Niacin.

Niaspan is "extended" release niacin, not "slow" release. I know this may sound like a mere play on words, but it is physiologically significant. The extended release action helps to prevent liver damage (indicated by the AST & ALT enzymes) during the first pass metabolism. Slow release niacin is merely an attempt to reduce the number and intensity of flushing episodes. I doubt it would be a problem to take the otc niacin until your Rx renews, but I would definitely stay on Niaspan.
One other thing, there is also a medication called Simcor. It is a Zocor (simvastatin) and Niaspan combination. Zocor is a very popular statin, and your Dr. may feel it to be a good substitute for Pravachol. The benefit would be one copay and only one pill to take. You may want to ask him about it on your next visit.

No - Don't mix any form of Extended Release Niacin with either plain or Sustained release. Besides, how do you know these over the counter niacins are really sustained release if they are not FDA approved. You don't kid around with niacin. Mixing the sustained niacins is where liver failure can become a reality. Immediate release is less of a problem if you take another immediate release (at the same dosage)..

It should be worth noting that there is no clinical differentiation between the terms "extended", "controlled", or "sustained". Actual dissolution testing of Niaspan, Endur-acin, and Slo-Niacin show they are quite similar, about 5 - 6 hr dissolution times, with niaspan actually being the slowest in this study!

The risk of hepatotoxicity has very little to do with the differences in these ER/SR preparations, rather how much and how often you take them (regimen). THIS POINT IS COMPLETELY OVER-LOOKED IN THE MEDICAL LITERATURE. IR is the safest and is routinely used up to 6 grams (6000mgs) per day. ER/SR preparations first came out without the understanding of the increased exposure to the live, and like IR niacin, were dosed similarly, ie 1000mg three times daily. These are the doses and regimen that are hepatotoxic. Dosing these preparations twice a day can still be very safe at 1000 - 2000mg total daily dose. This is the best tolerated regimen, and improves the LDL reduction at the expense of some HDL increase. Niaspan, contrary to what every physician in the USA has been told, does NOT have a unique dissolution. It did have a unique REGIMEN - once daily ER/SR niacin. This mimics IR niacin - that is, 2000mg all at once produces a high serum peak in the first hour that causes flushing, retains the HDL benefit of IR niacin, and with greater than 12hrs of no niacin exposure to the liver, is associated with very low liver enzyme increases.

One does need to take the choice of niacin seriously. Only products with adequate published data such that the kinetics, safety, and efficacy are known, should be used. Individual response to niacin varies, and physician monitoring of response needs to be done regardless of the preparation you choose for anyone trying to affect changes in their cholesterol.

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